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Saturday, 15 March 2014

This particular blog
post is fictional. Any resemblances to any person living or dead or
incidents current or historical are purely coincidental.

Warning: Legality could be injurious to health

It was the saddest day of his life.

Let us start from the
beginning. Bill was a brilliant student at A levels, he was also a
stickler for formality, rules and process. This stood him well and he
was very highly thought of as a scrupulous, proper, law abiding young man. He went on to study medicine,
completed junior general training and got into specialty training – all
very smoothly. His specialty also involved working in the operating
theatres.

Bill found within a few weeks of into his registrar job that his work never ever finished at 5 pm. Bill
being Bill, thought he will simply leave at 5 pm as long as there was
no patient he was directly dealing with was acutely ill. He did that for
a week. Bill then found his training was getting adversely affected.
Consultant ward rounds continued after 5 pm, if he did not join in he
cannot learn. Patients for elective surgery were admitted after 5 pm, if
he did not see them he will not be ready for them for the next day.
Theatres routinely over ran easily to 7 pm sometimes longer, if he was
not there he will lose out on the training.

Bill discussed this
with his consultants who looked at him as though he was an alien zombie.
When he insisted on resolution they told Bill that he is free to leave
at 5 pm if he wished to do so, some of them insisted that he leave at 5 pm so that he did not breach his hours. Bill’s logical argument was very simple,
substantial training happened after 5 pm so to take consultants’ advice
and leave at 5 pm means that he will never get the training he deserved.
So Bill refused to leave on the grounds of training needs and claimed
payment for extra time on the basis of actual time spent working at the
hospitals. Boy, this was resisted by the management. Bill was born
different, his documentation was perfect, they had no choice but to pay
him. The managers gave the consultants a hard time because of this issue; the consultants did
not take it lightly.

The time came to
‘assess’ and ‘report’ on Bill which were used at annual progress
meetings. These used to be called RITAs before now called ARCPs. Bill’s
numbers, performance, success rates, patient feedback and anything
clinical were spot on average. Bill’s consultant reports were full of
masked vitriol on how his attitude, behaviour, cooperation, et al were
not compatible with a surgical career. This was pointed out to him and
he made tremendous efforts to improve. Every time he was assessed
externally he had no issues on any of the ‘soft skills’ assessments. But he would not stop claiming for staying after contracted hours.
Every hospital that made him work after 5 pm paid up; the consultants
from the hospital wrote badly about his approach to life.

After 6 years of
completed training with same average clinical rating as his peer group,
Bill was denied his completion of training certificate due to five
reports that faulted his attitude. Bill cannot get into the specialist
register; Bill cannot be a substantive consultant in the NHS. His colleagues with his level of performance and achievement and some with lesser performance and achievement were signed off.

All because he
followed the country’s law and the NHS rules. The message his colleagues
got from their seniors was that people who followed the law can be
severely, career damagingly punished. The message other trainers and
managers got was that they can break the rules and law with impunity and
use their power to penalise the person who caught them out. Bill can go
to employment tribunals and the like but when he has at least half a
dozen consultants who have already written badly and a dozen managers
willing to write badly – he faces a lost cause. In a world where the subjective decimates the objective - he is a lost soul.

Has he learned his
lessons that legal and rule based behaviour does not win and not
submitting to the whims of the powerful was harmful? We do not know yet. This sounds like a case of operation successful, patient died; only here it will be training successful, career died. Bill hit the target, its the ricochet and the debris that maimed him.

Bill is at a crossroad waiting to change careers.

Oh by the way he also happens to belong to a minority ethnic group.

I think this quote from John le Carre (in his book The Constant Gardener) will probably be very appropriate here "Nobody
in this story, and no outfit or corporation, thank God, is based upon
an actual person or outfit in the real world. But I can tell you this;
as my journey through the pharmaceutical jungle progressed, I came to
realize that, by comparison with the reality, my story was as tame as a
holiday postcard."

I am not taking any moral stand here, pilots or anyone are welcome to entertain blonde girls or any other type of women or men anywhere. My problem arises when these pilots put passenger safety at risk by such acts.

I heard this news on the morning of 12 March 2014 on my way to the CHFG conference in Birmingham. I would have normally laughed out loud, then stay angered for a while and then move on. But there was something else bothering in my mind. Then at the conference, as in any healthcare conference these days, I heard a number of people repeating what has now become a cliché that healthcare should learn from pilots and airlines. What was bothering me then surfaced to provoke me into writing this blog.

If you thought for a minute that this cockpit privilege is dished out only in Malaysia or in some other distant country, you are probably mistaken and it may be time to change your mind.

A few weeks ago a colleague who is a senior doctor with additional responsibilities in the UK told me about travelling in the cockpit of a major airline on a scheduled short haul international flight in Europe. It was obviously very thrilling for the colleague but as a safety enthusiast it was disturbing me. As a senior doctor it might have been appropriate to decline the offer on the grounds of ensuring safety; that is another debate. If that colleague lied to show off etc that is a personal probity issue.

Then the colleague said that this privilege was also offered to another family member a couple of months earlier, who took a flight in the same sector for stag or a hen night. This is even more unsettling since it seems such behaviour by pilots are not one off or localised but probably frequent and international. Update: Since this blog was originally published about 48 hours ago, I have had a very senior doctor now retired telling me that he sat in the cockpit while flying over the Alps on the way to Italy. Goes to show that it is not only localised and frequent, it is also chronic poor behaviour by pilots.

I think the constant bu*****t about healthcare learning from pilots has to stop. This blog has argued for healthcare to learn from all sorts of good sources. I have previously written about animal air transport. I have written on the pilot error rates not falling since 1950s and the very large variation seen in the 'ultra-safe' airline industry. I still believe that healthcare needs to learn from everyone including airlines. But it should not be one-way traffic. Perhaps pilots can learn from doctors who will not pick out anyone from a waiting room on the basis of hair colour or allow 'friends' to join them in operating theatres as a thrill of the day.

We should not also make the error of mistakenly attributing the improvements allowed by technology as advances in human behaviours and interactions.